35 Priory Grove is registered to provide care and accommodation for a maximum of 4 people with a learning disability and may be living with dementia. The home is a purpose built bungalow, with four bedrooms, two toilets and one bathroom. Further accommodation is provided including; kitchen, laundry, lounge, dining area, conservatory and office. At the time of our inspection one person was using the service.

This unannounced inspection took place on 3 February. The last inspection of the service took place on the 20, 21 and 27 of January 2016 and we found the registered provider had made improvements in the way the service was managed. Improved monitoring systems had been put in place following the last inspection that helped to audit and improve the care provided to people. We saw Improvements had been made to the management of risk. However, we saw confidential files were not

stored securely.

During this inspection we saw that the registered provider had taken action to ensure that confidential files were held securely and the new audits system introduced had been successful in identifying shortfalls within the service so that action could be taken to address these in a timely way.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The person who used the service had complex needs and was not always able to tell us in detail about their experiences. We used a number of different methods to help us understand the experiences of the person who used the service including the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experiences of people who were unable to speak with us. It was clear the person who used the service trusted the staff who supported them. Staff were observed to look for visual cues as well as listening to the tone and pitch of the person’s verbalisation, in order to understand what they were trying to communicate.

The person who used the service was supported by suitable numbers of staff who knew how to keep them safe. The registered provider had developed plans to deal with foreseeable emergencies. Staff had been recruited safely following the completion of appropriate checks. Medicines were ordered, stored and administered safely and people received their medicines as prescribed.

Staff understood how to gain consent from people who used the service; the principles of the Mental Capacity Act 2005 were followed when people were unable to make specific decisions themselves.

The person who used the service had their nutritional and dietary needs assessed and they were supported to eat and drink sufficient amounts to maintain their health. They were also supported by a range of healthcare professionals to ensure their needs were met effectively.

The staff and registered manager were responsive to people’s changing needs. Reviews of the person’s care took place on a regular basis; the person and their appointed representative were involved in the initial and on-going planning of their care. Care plans had been developed which focused on supporting the person to maintain and develop daily living skills whilst remaining safe.

The person who used the service took part in a range of activities and went to social events. The registered provider had a complaints policy in place that had been created in a format that made it accessible to the people who used the service.

The service was led by a registered manager who understood their responsibilities to inform the CQC when specific incidents occurred. A quality assurance system was in place that consisted of audits, daily checks and questionnaires. Action was taken to improve

We undertook this unannounced inspection on the 20, 21 and 27 of January 2016. At the last inspection on 13, 18 and 19 August 2015 we found the registered provider was non-compliant in five of the areas we assessed. We issued compliance actions for concerns in person centred care, safeguarding people from improper treatment, obtaining consent and working within the requirements of the Mental Capacity Act 2005, and assessing and monitoring the quality of service provision. A warning notice was issued regarding how people were not protected against the risks associated with receiving poor care and failing to monitor the level of care people received effectively. During this comprehensive inspection we found improvements had been made in all areas. We have rated three of the individual key questions, ‘Responsive’, ‘Effective’ and ‘Caring’ as good and we have changed the rating in ‘Well led’ from inadequate to requires improvement. The rating in ‘Safe’ has been rated as requires improvement without a breach. The overall rating for the service is requires improvement; this is because we want to monitor the improvements further to be sure they are sustained over a period of time.

35 Priory Grove is registered to provide care and accommodation for a maximum of 4 people with a learning disability and may be living with dementia. The home is a purpose built bungalow, with four bedrooms, two toilets and one bathroom. Further accommodation is provided including; kitchen, laundry, lounge, dining area, conservatory and office.

The service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found people were protected from the risk of abuse or harm. Staff were aware of how to use the policies and procedures to safeguard people and when to make referrals to the local safeguarding team. Risk assessments for the management of changing behaviours needed to be more detailed to ensure least restrictive practice. Confidential files were found to be not stored securely. The cupboard door and the door of the room these were stored in were both unlocked and left ajar.

We found people’s health and nutritional needs were met. People were able to see their GP or other health professionals such as dieticians and occupational therapists as required. Menus provided people with a choice of meals and there was plenty of fresh fruit and vegetables available in the service.

People were seen to be treated with dignity and respect, and care was planned and delivered in a more person centred way. We observed staff interacted well with people, knew their likes and dislikes and demonstrated a caring and attentive approach.

We found staff supported people to make their own decisions on a day to day basis; they held meetings to discuss options when people lacked capacity to do this by themselves. Where people were deprived of their liberty to protect their safety, staff had ensured this was done in the least restrictive way and in line with current legislation. Some staff required further training or support to develop their understanding of the principles of the Mental Capacity Act 2005.

We saw staff provided information and explanations to people before carrying out tasks for them such as supporting them with meals.

We found staff were recruited safely and there were sufficient numbers of staff with different skills and experience on duty day and night in order to meet people’s assessed needs. Staff had received training, supervision and appraisal in order for them to feel supported and confident when caring for people.

We found improvements had been made in the way the service was managed. A new quality assurance system had been d

This inspection was unannounced and took place on 13, 18 and 19 August 2015. This was the first inspection of this service.

35 Priory Grove is registered to provide care and accommodation for a maximum of 4 people who have a learning disability and may be living with dementia. The home is a purpose-built bungalow, with four bedrooms, two toilets and one bathroom. It has a large communal area and a garden to the rear.

The service had a registered manager at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found the registered provider was in breach of four regulations of the Health and Social Care Act 2008 [Regulated Activities] Regulations 2014. These were in relation to person-centred care, safeguarding people from abuse and improper treatment, obtaining consent and working within the requirements of the Mental Capacity Act 2005, and assessing and monitoring the quality of service provision. We have deemed these breaches to have a moderate impact on people who used the service. We also found a breach of Regulation 18 of the Care Quality Commission [Registration] Regulations 2009 for non-notification of incidents.

Systems used by the registered provider to assess the quality of the service were ineffective. A quality monitoring programme was in place, however shortfalls in the level of service were not highlighted; therefore action was not taken to improve the service as required.

During the inspection we witnessed an episode of poor and inappropriate care whilst staff were attempting to support someone with personal care. When we spoke with the registered manager it became apparent they were aware of how the care was delivered and had failed to take appropriate action.

The registered manager and staff had completed training in relation to the Mental Capacity Act 2005 [MCA] but it was clear their understanding of the need to have appropriate consent in place was lacking. Decisions had not been made in an appropriate best interest forum and in accordance with current legislation, to ensure people received care and treatment that was in their best interest.

A number of healthcare professionals were involved with the care and treatment of the people who used the service. However, we found that advice and guidance had not been incorporated into support plans and risk assessments which put people at risk of receiving ineffective and inappropriate care.

We found evidence to confirm people’s support plans and risk assessments were no longer accurate and did not reflect their current needs.

Staff told us they had completed an in-depth induction process, a range of training and that they received appropriate support and guidance during supervisions and annual appraisals. The registered provider’s training matrix provided evidence staff had completed training in areas such as moving and handling, health and safety, dementia and the safe handling of medication. The registered manager told us staff had also undertaken a nationally recognised qualification in care.

Medicines were managed safely. The registered provider had policies that provided guidance on the safe ordering, storage, administration and destruction of medication. We observed staff administering medication; we noted it was done patiently and staff explained what the medication was and the reason the person required it.

Relatives we spoke with told us the staff who supported their family member were kind and attentive to their needs.

People were supported by suitable numbers of staff who had been recruited safely. Before prospective staff commenced working within the service, checks were completed to ensure they were suitable to work with vulnerable people.